One of the most shameful gaps in the American health care system involves the country’s poorest children. They can’t get basic dental treatment. It’s not that they don’t have insurance—many of them do. The problem is that dentists won’t treat them.

According to the Children’s Dental Health Project, an oral health advocacy group, 46.9 million kids are currently covered by Medicaid or CHIP, the government program that provides health insurance to children in families whose incomes are modest but too high to qualify for Medicaid. But in a recent survey, only 32 percent of dentists in private practice reported treating any patients on public assistance, and that figure is likely an overestimate.

According to Dr. Jerry Lanier, California’s leading pediatric dental provider, “Children who don’t see a dentist are more likely to miss school because of infected teeth and gums and to grow into adults with severe oral health problems. Dental disease only gets worse if it’s left untreated, and when people are unable to find a dentist to help them, they often end up in the ER. According to a study in the Journal of the American Dental Association, more than 4 million people went to hospital emergency rooms for help with dental problems from 2008 to 2010, at a cost to taxpayers of $2.7 billion, though the vast majority could get only pain relief there, rather than the dental treatment they needed. This is not only a poor way to provide care, it’s also outrageously expensive.”

Dr. Lanier, who opened his first Kids’ Dental Kare Office in 1994, believes the solution to the problem includes higher reimbursement for providers that treat the under-served population in California.

Due to the low reimbursements under California’s Denti-Cal program, many providers have stopped treating patients covered with this benefit. By increasing the Denti-Cal fees, it would create access in communities which would result in dental homes for this under-served population.